Essays
Creating Smiles: Reflections on a Calling (2004) Jessica A. Meeske '91
At thirty-five years of age, I have spent more time in higher education than I have in my chosen profession. Four years of college, four years of dental school, and a three-year master's program have kept me occupied most of my adult life. My goal, almost from the start, was to become a pediatric dentist. My path in this decision, and how I strive for that magical balance between my professional and personal life, is what I'd like to reflect on in this essay. I hope to offer some insight into why my job is more than a mere occupation. It is a calling — if a scientist can use such terminology — and one that provides a great deal of meaning in my life.
I was raised in Murray, Nebraska, and have always appreciated the fact that my childhood was spent in a small town where people knew and cared for each other. I guess you could say I had a typical Midwestern upbringing: lazy summers swimming in the lake, football games in the fall, sledding parties with my friends on snowy winter afternoons. My only real problem in my early years was health-related: I was born with a small mouth and a narrow palate. Fortunately, I had a good general dentist who diagnosed the problem early and had the foresight to refer me to a specialist. He noted that pediatric dentists have more expertise in taking care of children with severe dental problems. Because my difficulties were related to severe dental crowding, my new dentist, in conjunction with an orthodontist, spent thirteen years reshaping my mouth. I didn't know it then, but this period in my life would be formative as I began to think about my own vocation and career path.
By the age of eight, frequent trips to the dentist were a natural part of my routine. Every month I would spend hours in the car with my parents, driving sixty miles to and from Omaha for my appointments. Eventually, this became a full-fledged community event. There was a group of five of us, all in the same school, whose parents worked full-time, so each parent would take a turn hauling us to and from the big city for our orthodontic appointments. After our visits, it was always a treat to stop for lunch at McDonald's, especially since our small town of 500 didn't have any Golden Arches of its own. The only problem was, with our newly adjusted hardware, our mouths were often too sore for any of us to enjoy our burgers and fries. So there were very few "happy meals" consumed on those occasions. Overall, I endured twelve teeth being extracted (to create room), a palatal expander (to physically widen my upper jaw), full braces (to guide tooth eruption and straighten), and retainers (to keep things from moving back to their original state). Each new appliance meant that I had to adapt my speech, or words like "sunglasses" would come out as "thunglathith."
Adolescence is difficult enough without having to be self-conscious about one's smile. I truly thought that my friends who didn't have to endure braces were the luckiest people in the world. Looking back, though, the pain was well worth the gain, and I'm thankful now for things I could not fully appreciate then. Being from a middle-income family, my parents made many financial sacrifices to ensure that my mouth and smile would be transformed from a buck-toothed, ugly duckling, pre-adolescent to a teenager whose smile might leave others with a positive first impression. Education and health care were given highest priority in our home, and this meant that purchases of other amenities — such as dining out, new clothes, and fancy vacations — were delayed or foregone altogether. In the end, my mother and father spent about as much on my comprehensive dental care as they would have on a new car.
While I didn't particularly enjoy the whole braces thing, I do remember visits to the pediatric dental clinic as being fun (strange as this may sound). There was always the hustle and bustle of many children of all ages, and dental staff cleaning teeth and entertaining the patients. The waiting room had that weird yet familiar dental office smell, like warm cloves. I remember it as a cheerful place where people were kind, compassionate, and helpful. They seemed genuinely interested in me and made me feel like I was their only concern. It was kind of sad, then, when Dr. Driscoll told me that his role in my care had come to an end and it was time for me to move on to a general dentist. I didn't want to go. I mean, so what if I was eighteen and my feet hung off the end of that Big Bird yellow dental chair? The office had become a very comforting place for me, and the people there had made a great impact on my life.
It wasn't until much later that I came to appreciate how fortunate I was that my parents could provide good dental care for both me and my sister. All those normal teenager activities like cheerleading at a game, or kissing my first boy, were made better with a good smile and a healthy dose of self-confidence. By the time I was a senior in high school, I was giving serious thought to a career in pediatric dentistry. It seemed to encompass all the things I was looking for: a chance to help people and work with children, an ability to work independently, and the opportunity to be my own boss.
The undergraduate liberal arts program at Hastings College provided an excellent foundation for me as I began to look ahead to my dental career. Small class sizes meant that I was forced to know and work with my classmates. Leadership opportunities provided me with experience on a modest scale, and in a low-risk environment. The faculty held high expectations, making me accountable for my academic outcomes. Professionalism was evident throughout the campus and there were plenty of excellent mentors willing to reach out and offer help to any student at any time. I was fortunate to have Dr. Fred Mattes as my advisor. Dr. Mattes was never one to allow his students to sign up for easy classes as a way of getting easy A's. He would always insist that a "hard earned B would get you a lot farther in life," and he was right. He also expected me to get involved in campus life as a way to enrich my academic experience.
When I moved on to dental school, it was tough, but I was well prepared. Between 1992 and 1996 I was enrolled at the University of Missouri School of Dentistry in Kansas City. My first year was one of the biggest academic tests of my life. It was filled with difficult basic science courses and lab work. Clinical dental training involves becoming competent on plastic teeth in the mouths of plastic models. I have vivid memories of those early days of learning how to gauge the speed and pressure of my drill by the smell of burning plastic. Obviously, this unpleasant aroma was indicative of theoretically frying the pulp in the tooth of a real patient, which is something we dentists like to avoid.
Dentistry has over nine specialty areas and provides several career paths including private clinical practice, teaching, research, public health, health advocacy, military, and industry. I was a sophomore in dental school when I confirmed what I'd only previously suspected as my calling. It happened one day when I was in the pediatric clinic treating a five-year-old child with severe dental disease. He had over fifteen badly decayed teeth, facial swelling caused by a dental abscess, and he could not stop crying for the pain. To complicate matters, he spoke no English, and his family had no means of paying for his care. His mother indicated that the toothaches had been present on and off for over six months. When I asked for faculty assistance to help this child, I was told simply to do what I could to relieve his discomfort because there were dozens of others in the waiting room with similar problems.
I left that day feeling frustrated and helpless. Earlier that morning I had completed multiple esthetic procedures on a young woman to make her very normal smile even more radiant. But with this child, I found myself being left to treat the symptom of a much larger disease, and one that was running way out of control. I wanted to address the whole child, the cause of the dental disease, formulate a treatment plan, address the potential behavior management issues, and seek help with the communication barriers, but my hopes were shot down by "real world" barriers. I was very frustrated: how could we in this country, and in this era, have more than sufficient knowledge and technology to help this child yet continually run up against so many obstacles to adequate care? My training had ensured that I knew how to diagnose and treat most dental conditions, but it left me ill-equipped to work through the political, social, cultural, and economic barriers that prevent the most basic care. By the time I had completed my four years of dental school, I had taken over 50 courses; only one was dedicated to dental public health issues.
Here is the problem. For many children, dental disease and pain are chronic conditions that many simply have to endure. Tooth decay is the single most common chronic disease in childhood1. In the U.S., about twenty-five percent of the children have eighty percent of the dental disease2. Furthermore, dental disease is disproportionately higher in children who are Asian and Pacific Islanders, followed by Hispanics, African-Americans and white children3, as well as children of low-income families4. There are 2.6 children lacking dental coverage for every child who lacks health coverage. While many of these kids are covered by Medicaid (the insurance program for low-income and disabled children), only a small percentage have had their first dental visit by the age of five. Unlike many other childhood illnesses, dental decay is entirely preventable. For a variety of reasons, however, kids enrolled in the Dental Medicaid Program are unable to gain access to care. Fewer than twenty percent of children enrolled in Medicaid had a dental visit last year.
From that point in my education I knew my work would be dedicated to finding ways to better care for children who were at the highest risk for dental disease and were the least likely to get help. This is certainly a different path than the one chosen by many of my professional colleagues. The majority practice by themselves or in small groups. It is primarily a cottage industry where the old cliché of "drill, fill, and bill" occupies the largest portion of the workday. Most consultants will tell you that a successful dental practice is one that keeps its schedule full and maximizes profit margins. In other words, the bottom line is the bottom line. This is not to say that many dentists don't provide a significant amount of pro bono work. Many do. However, as a profession we don't do as well as we could when it comes to getting care to those who face the greatest amount of disease and need our services the most.
While taking home a good income in private practice was certainly a benefit that I was looking forward to in my professional life, I never considered it to be an end in itself. There were deeper problems that needed to be solved. How could I get good care to the kids who needed it most? How could I work to prevent as much oral disease as possible within populations of children? Finally, how could I do this and stay motivated, have a fulfilling personal life, and go home feeling good at the end of each day?
Making the kind of impact that I hoped to make was going to take more than pursuing a traditional residency in pediatric dentistry. I needed something more to help me get to the core of the problem and offer long-term solutions. This prompted me to seek dual specialty training in both pediatric dentistry and dental public health. In 1999, I completed an M.S. degree in dental public health and a certificate in pediatric dentistry at the University of Iowa. The pediatric dentistry part of my education helps me to care for individual patients, and the public health part allows me to address dental public health issues on a larger scale.
I am now in my fifth year of practice. I have found that running a pediatric clinic is a constant struggle to help children in need who have few resources and a less than stable family life. It is a task that requires a myriad of skills, some of which I have, and others I'm still cultivating. These include being competent in the diagnosis and treatment of patients, often working with modestly educated parents on how to prevent further disease, working with government agencies to get children dental benefits or report abuse and neglect, and working with educational programs like Head Start. Finally, and perhaps most difficult of all, is the task of getting families to follow through with preventive and treatment recommendations.
This epidemic of untreated dental disease must be addressed from the community, state, national, and international level. I have found this part of my work to be one of my most meaningful and satisfying experiences. My involvement at these various levels has kept my life and work in perspective. Local and state initiatives to improve oral health of needy children are challenging and time consuming. It sometimes means canceling patient appointments at a day's notice so I can testify on a bill in the state legislature. Most recently, I have become a legislative fellow at the Children's Dental Health Project, a Washington policy think-tank dedicated to improving access to dental care for children. This involves advocacy efforts in Congress to fund health services research and programs that improve dental health for children.
Marriage and motherhood have complemented my work and even further increased its relevance to me. I have been married for fifteen years and have enjoyed the support of a wonderful husband, someone who also knows and understands the medical profession. I have two children of my own — both of whom are very different — and this helps me to see my patients in a new light. Each has a unique personality and ability to cope. Mothers and fathers often experience feelings of guilt about their child's dental condition, or even anxiety towards what will be required to treat them. I, too, have now experienced this anxiety that only a parent can feel when his or her child needs emergency care.
My expectations for myself as a wife, mother, and member of a community are in many ways a reflection of what I saw my own mother do when she raised my sister and me. Besides her own work, she was always busy hauling us to piano lessons, baking cookies for bake sales, entertaining friends, and teaching Sunday school. And, of course, there were those long, laborious trips to Omaha and back. Somehow, in all of this, she never forgot when I needed a clean jersey for a ballgame, or when all the permission slips for the school field trips needed to be signed. I wish I knew her system. I have found that I cannot keep up with all the expectations that I place on myself, and society places on me, because of my career choice. I've had to define my own role as spouse, parent, and community volunteer. It is still a work in progress.
Finally, I will share something about the "magical balance between work and family." The truth is, it really doesn't exist. There is no "magic." Each of us who strives to find fulfillment has to create a personal strategy that works — at home, in the work place, and in one's heart. Much of our own formula for success will be influenced by the work we choose, and with whom we choose to spend our lives. Some of it we will have to make up as we go.
I can only leave you with this: try to let your desire to "make a difference" guide you in what you do, as opposed to the more tangible and typical rewards that society has defined as "success." Choose to spend your life with someone who values your personal goals as much as his or her own. Be sure that he or she is equally committed to working for the greater good of humanity. You can measure the rewards of your work with many benchmarks. Hopefully you will use those that will assure you'll leave the woodpile higher than you found it. I would further challenge you to approach both your work life and home life with the same amount of effort and commitment. This will require continuous goal setting, assessment, strategic planning, and fostering of human relationships that are essential to finding your best personal balance in life.
--------------------------
1 Edelstein, et al, 1995, "Dispelling the Myth That 50% of U.S. Schoolchildren Have Never Had A Cavity," Public Health Reports 110:522-30
2 Kaste, et al, 1996, "Coronal Caries in the Primary and Permanent Dentition of Children and Adolescents 1-17 years of Age in the U.S. 1988-91," Journal of Dental Research 75 (Special Issue): 631-41
3 Kaste, et al 1996
4 Vargas, et al, 1998, "Sociodemographic Distribution of Pediatric Dental Caries: NHANES III, 1988-94," Journal of the American Dental Association 129:1229-38.
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Creating Smiles: Reflections on a Calling (2004) Jessica A. Meeske '91
At thirty-five years of age, I have spent more time in higher education than I have in my chosen profession. Four years of college, four years of dental school, and a three-year master's program have kept me occupied most of my adult life. My goal, almost from the start, was to become a pediatric dentist. My path in this decision, and how I strive for that magical balance between my professional and personal life, is what I'd like to reflect on in this essay. I hope to offer some insight into why my job is more than a mere occupation. It is a calling — if a scientist can use such terminology — and one that provides a great deal of meaning in my life.
I was raised in Murray, Nebraska, and have always appreciated the fact that my childhood was spent in a small town where people knew and cared for each other. I guess you could say I had a typical Midwestern upbringing: lazy summers swimming in the lake, football games in the fall, sledding parties with my friends on snowy winter afternoons. My only real problem in my early years was health-related: I was born with a small mouth and a narrow palate. Fortunately, I had a good general dentist who diagnosed the problem early and had the foresight to refer me to a specialist. He noted that pediatric dentists have more expertise in taking care of children with severe dental problems. Because my difficulties were related to severe dental crowding, my new dentist, in conjunction with an orthodontist, spent thirteen years reshaping my mouth. I didn't know it then, but this period in my life would be formative as I began to think about my own vocation and career path.
By the age of eight, frequent trips to the dentist were a natural part of my routine. Every month I would spend hours in the car with my parents, driving sixty miles to and from Omaha for my appointments. Eventually, this became a full-fledged community event. There was a group of five of us, all in the same school, whose parents worked full-time, so each parent would take a turn hauling us to and from the big city for our orthodontic appointments. After our visits, it was always a treat to stop for lunch at McDonald's, especially since our small town of 500 didn't have any Golden Arches of its own. The only problem was, with our newly adjusted hardware, our mouths were often too sore for any of us to enjoy our burgers and fries. So there were very few "happy meals" consumed on those occasions. Overall, I endured twelve teeth being extracted (to create room), a palatal expander (to physically widen my upper jaw), full braces (to guide tooth eruption and straighten), and retainers (to keep things from moving back to their original state). Each new appliance meant that I had to adapt my speech, or words like "sunglasses" would come out as "thunglathith."
Adolescence is difficult enough without having to be self-conscious about one's smile. I truly thought that my friends who didn't have to endure braces were the luckiest people in the world. Looking back, though, the pain was well worth the gain, and I'm thankful now for things I could not fully appreciate then. Being from a middle-income family, my parents made many financial sacrifices to ensure that my mouth and smile would be transformed from a buck-toothed, ugly duckling, pre-adolescent to a teenager whose smile might leave others with a positive first impression. Education and health care were given highest priority in our home, and this meant that purchases of other amenities — such as dining out, new clothes, and fancy vacations — were delayed or foregone altogether. In the end, my mother and father spent about as much on my comprehensive dental care as they would have on a new car.
While I didn't particularly enjoy the whole braces thing, I do remember visits to the pediatric dental clinic as being fun (strange as this may sound). There was always the hustle and bustle of many children of all ages, and dental staff cleaning teeth and entertaining the patients. The waiting room had that weird yet familiar dental office smell, like warm cloves. I remember it as a cheerful place where people were kind, compassionate, and helpful. They seemed genuinely interested in me and made me feel like I was their only concern. It was kind of sad, then, when Dr. Driscoll told me that his role in my care had come to an end and it was time for me to move on to a general dentist. I didn't want to go. I mean, so what if I was eighteen and my feet hung off the end of that Big Bird yellow dental chair? The office had become a very comforting place for me, and the people there had made a great impact on my life.
It wasn't until much later that I came to appreciate how fortunate I was that my parents could provide good dental care for both me and my sister. All those normal teenager activities like cheerleading at a game, or kissing my first boy, were made better with a good smile and a healthy dose of self-confidence. By the time I was a senior in high school, I was giving serious thought to a career in pediatric dentistry. It seemed to encompass all the things I was looking for: a chance to help people and work with children, an ability to work independently, and the opportunity to be my own boss.
The undergraduate liberal arts program at Hastings College provided an excellent foundation for me as I began to look ahead to my dental career. Small class sizes meant that I was forced to know and work with my classmates. Leadership opportunities provided me with experience on a modest scale, and in a low-risk environment. The faculty held high expectations, making me accountable for my academic outcomes. Professionalism was evident throughout the campus and there were plenty of excellent mentors willing to reach out and offer help to any student at any time. I was fortunate to have Dr. Fred Mattes as my advisor. Dr. Mattes was never one to allow his students to sign up for easy classes as a way of getting easy A's. He would always insist that a "hard earned B would get you a lot farther in life," and he was right. He also expected me to get involved in campus life as a way to enrich my academic experience.
When I moved on to dental school, it was tough, but I was well prepared. Between 1992 and 1996 I was enrolled at the University of Missouri School of Dentistry in Kansas City. My first year was one of the biggest academic tests of my life. It was filled with difficult basic science courses and lab work. Clinical dental training involves becoming competent on plastic teeth in the mouths of plastic models. I have vivid memories of those early days of learning how to gauge the speed and pressure of my drill by the smell of burning plastic. Obviously, this unpleasant aroma was indicative of theoretically frying the pulp in the tooth of a real patient, which is something we dentists like to avoid.
Dentistry has over nine specialty areas and provides several career paths including private clinical practice, teaching, research, public health, health advocacy, military, and industry. I was a sophomore in dental school when I confirmed what I'd only previously suspected as my calling. It happened one day when I was in the pediatric clinic treating a five-year-old child with severe dental disease. He had over fifteen badly decayed teeth, facial swelling caused by a dental abscess, and he could not stop crying for the pain. To complicate matters, he spoke no English, and his family had no means of paying for his care. His mother indicated that the toothaches had been present on and off for over six months. When I asked for faculty assistance to help this child, I was told simply to do what I could to relieve his discomfort because there were dozens of others in the waiting room with similar problems.
I left that day feeling frustrated and helpless. Earlier that morning I had completed multiple esthetic procedures on a young woman to make her very normal smile even more radiant. But with this child, I found myself being left to treat the symptom of a much larger disease, and one that was running way out of control. I wanted to address the whole child, the cause of the dental disease, formulate a treatment plan, address the potential behavior management issues, and seek help with the communication barriers, but my hopes were shot down by "real world" barriers. I was very frustrated: how could we in this country, and in this era, have more than sufficient knowledge and technology to help this child yet continually run up against so many obstacles to adequate care? My training had ensured that I knew how to diagnose and treat most dental conditions, but it left me ill-equipped to work through the political, social, cultural, and economic barriers that prevent the most basic care. By the time I had completed my four years of dental school, I had taken over 50 courses; only one was dedicated to dental public health issues.
Here is the problem. For many children, dental disease and pain are chronic conditions that many simply have to endure. Tooth decay is the single most common chronic disease in childhood1. In the U.S., about twenty-five percent of the children have eighty percent of the dental disease2. Furthermore, dental disease is disproportionately higher in children who are Asian and Pacific Islanders, followed by Hispanics, African-Americans and white children3, as well as children of low-income families4. There are 2.6 children lacking dental coverage for every child who lacks health coverage. While many of these kids are covered by Medicaid (the insurance program for low-income and disabled children), only a small percentage have had their first dental visit by the age of five. Unlike many other childhood illnesses, dental decay is entirely preventable. For a variety of reasons, however, kids enrolled in the Dental Medicaid Program are unable to gain access to care. Fewer than twenty percent of children enrolled in Medicaid had a dental visit last year.
From that point in my education I knew my work would be dedicated to finding ways to better care for children who were at the highest risk for dental disease and were the least likely to get help. This is certainly a different path than the one chosen by many of my professional colleagues. The majority practice by themselves or in small groups. It is primarily a cottage industry where the old cliché of "drill, fill, and bill" occupies the largest portion of the workday. Most consultants will tell you that a successful dental practice is one that keeps its schedule full and maximizes profit margins. In other words, the bottom line is the bottom line. This is not to say that many dentists don't provide a significant amount of pro bono work. Many do. However, as a profession we don't do as well as we could when it comes to getting care to those who face the greatest amount of disease and need our services the most.
While taking home a good income in private practice was certainly a benefit that I was looking forward to in my professional life, I never considered it to be an end in itself. There were deeper problems that needed to be solved. How could I get good care to the kids who needed it most? How could I work to prevent as much oral disease as possible within populations of children? Finally, how could I do this and stay motivated, have a fulfilling personal life, and go home feeling good at the end of each day?
Making the kind of impact that I hoped to make was going to take more than pursuing a traditional residency in pediatric dentistry. I needed something more to help me get to the core of the problem and offer long-term solutions. This prompted me to seek dual specialty training in both pediatric dentistry and dental public health. In 1999, I completed an M.S. degree in dental public health and a certificate in pediatric dentistry at the University of Iowa. The pediatric dentistry part of my education helps me to care for individual patients, and the public health part allows me to address dental public health issues on a larger scale.
I am now in my fifth year of practice. I have found that running a pediatric clinic is a constant struggle to help children in need who have few resources and a less than stable family life. It is a task that requires a myriad of skills, some of which I have, and others I'm still cultivating. These include being competent in the diagnosis and treatment of patients, often working with modestly educated parents on how to prevent further disease, working with government agencies to get children dental benefits or report abuse and neglect, and working with educational programs like Head Start. Finally, and perhaps most difficult of all, is the task of getting families to follow through with preventive and treatment recommendations.
This epidemic of untreated dental disease must be addressed from the community, state, national, and international level. I have found this part of my work to be one of my most meaningful and satisfying experiences. My involvement at these various levels has kept my life and work in perspective. Local and state initiatives to improve oral health of needy children are challenging and time consuming. It sometimes means canceling patient appointments at a day's notice so I can testify on a bill in the state legislature. Most recently, I have become a legislative fellow at the Children's Dental Health Project, a Washington policy think-tank dedicated to improving access to dental care for children. This involves advocacy efforts in Congress to fund health services research and programs that improve dental health for children.
Marriage and motherhood have complemented my work and even further increased its relevance to me. I have been married for fifteen years and have enjoyed the support of a wonderful husband, someone who also knows and understands the medical profession. I have two children of my own — both of whom are very different — and this helps me to see my patients in a new light. Each has a unique personality and ability to cope. Mothers and fathers often experience feelings of guilt about their child's dental condition, or even anxiety towards what will be required to treat them. I, too, have now experienced this anxiety that only a parent can feel when his or her child needs emergency care.
My expectations for myself as a wife, mother, and member of a community are in many ways a reflection of what I saw my own mother do when she raised my sister and me. Besides her own work, she was always busy hauling us to piano lessons, baking cookies for bake sales, entertaining friends, and teaching Sunday school. And, of course, there were those long, laborious trips to Omaha and back. Somehow, in all of this, she never forgot when I needed a clean jersey for a ballgame, or when all the permission slips for the school field trips needed to be signed. I wish I knew her system. I have found that I cannot keep up with all the expectations that I place on myself, and society places on me, because of my career choice. I've had to define my own role as spouse, parent, and community volunteer. It is still a work in progress.
Finally, I will share something about the "magical balance between work and family." The truth is, it really doesn't exist. There is no "magic." Each of us who strives to find fulfillment has to create a personal strategy that works — at home, in the work place, and in one's heart. Much of our own formula for success will be influenced by the work we choose, and with whom we choose to spend our lives. Some of it we will have to make up as we go.
I can only leave you with this: try to let your desire to "make a difference" guide you in what you do, as opposed to the more tangible and typical rewards that society has defined as "success." Choose to spend your life with someone who values your personal goals as much as his or her own. Be sure that he or she is equally committed to working for the greater good of humanity. You can measure the rewards of your work with many benchmarks. Hopefully you will use those that will assure you'll leave the woodpile higher than you found it. I would further challenge you to approach both your work life and home life with the same amount of effort and commitment. This will require continuous goal setting, assessment, strategic planning, and fostering of human relationships that are essential to finding your best personal balance in life.
--------------------------
1 Edelstein, et al, 1995, "Dispelling the Myth That 50% of U.S. Schoolchildren Have Never Had A Cavity," Public Health Reports 110:522-30
2 Kaste, et al, 1996, "Coronal Caries in the Primary and Permanent Dentition of Children and Adolescents 1-17 years of Age in the U.S. 1988-91," Journal of Dental Research 75 (Special Issue): 631-41
3 Kaste, et al 1996
4 Vargas, et al, 1998, "Sociodemographic Distribution of Pediatric Dental Caries: NHANES III, 1988-94," Journal of the American Dental Association 129:1229-38.
